Emergence of Methadone as a Street Drug in St. Petersburg, Russia
BACKGROUND:
The
syndemic of opioid addiction, HIV, hepatitis, tuberculosis, imprisonment, and
overdose in Russia has been worsened by the illegality of opioid substitution
therapy. As part of on-going serial studies, we sought to explore the influence
of opioid availability on aspects of the syndemic as it has affected the city
of St. Petersburg.
METHODS:
We
employed a sequential approach in which quantitative data collection and
statistical analysis were followed by a qualitative phase. Quantitative data
were obtained in 2013-2014 from a respondent-driven sample (RDS) of people who
inject drugs (PWID). Individuals recruited by RDS were tested for antibodies to
HIV and interviewed about drug use and injection practices, sociodemographics,
health status, and access to medical care. Subsequently, we collected in-depth
qualitative data on methadone use, knowledge, and market availability from PWID
recruited at nine different locations within St. Petersburg.
RESULTS:
Analysis
of interview data from the sample revealed the percentage of PWID injecting
methadone in the 30 days prior to interview increased from 3.6% in 2010 to
53.3% in 2012-2013. Injection of only methadone, as compared to injecting only
heroin or both drugs, was associated with less frequent injection and reduced
HIV-related injected risk, especially a lower rate of injecting with a
previously used syringe. In-depth questioning of methadone injectors
corroborated the finding from serial quantitative surveys of PWID that
methadone's black market availability is a recent phenomenon. Spatial analysis
revealed widespread methadone availability but no concentration in any specific
districts of the city.
CONCLUSION:
Despite
the prohibition of substitution therapy and demonization of methadone, the drug
has emerged to rival heroin as the most commonly available opioid in St.
Petersburg. Ironically, its use is associated with reduced injection-related
HIV risk even when its use is illegal.
- 1Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA. Electronic address: robert.heimer@yale.edu.
- 2NGOStellit, St. Petersburg, Russia.
- 3Center for Interdisciplinary Research on AIDS and Department of the Epidemiology of Microbial Disease, Yale University School of Public Health, New Haven, CT, USA
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